Abstract
PurposeThe orbital apex is the narrowest part of the orbit, housing the link between the intracranial cavity and orbit. Knowledge of orbital apex anatomy is crucial to selecting a surgical approach and reducing the risk of complications. Our purpose is to summarize current knowledge on surgical anatomy and attempt to reach a consensus on definition of the orbital apex.MethodsThe online databases of Embase, the Cochrane library, Web of Science and PubMed (MEDLINE) were queried in a comprehensive bibliographic search on the (surgical) anatomy of the orbital apex and consisted of a combination of two subjects, using indexed terms and free text: “Orbital Apex” and “Orbital Anatomy.”ResultsA total of 114 relevant papers were included in this review. Numerous anatomical variations are described in the literature. Variations of the optic canal include duplication (0.64%) and keyhole anomaly (2.65%). Variations in pneumatization of the anterior clinoid process were unilateral in almost 10%, bilateral in 9%, and normal in 72%. A rare variant of the superior orbital fissure (SOF) is Warwick’s foramen, which appears as if the lowest portion of the SOF was separated from the main fissure by a transverse bony bridge.ConclusionThe definition of the orbital apex varies in the literature, and further research would most likely identify additional variations. A universal definition reporting these variations and pathology and imaging findings is essential for determining the optimal surgical approach to the orbital apex.
Highlights
The orbital apex is the area between the orbit and intracranial space that houses structures like the optic canal (OC), superior orbital fissure (SOF), and inferior orbital fissure (IOF), forming an opening to the orbit [2, 19, 30, 52, 92, 94, 108]
The full texts of 222 articles describing the anatomy of the orbital apex and the important structures related to this area were assessed for eligibility
The bony orbital apex is the narrowest part of the orbit
Summary
The orbital apex is the area between the orbit and intracranial space that houses structures like the optic canal (OC), superior orbital fissure (SOF), and inferior orbital fissure (IOF), forming an opening to the orbit [2, 19, 30, 52, 92, 94, 108]. The superolateral orbit can be divided in the frontal. Detailed anatomical knowledge of the orbital apex is essential for diagnostic purposes and surgical interventions because critical structures are only millimeters apart [27, 79, 92, 104]. The literature describes many variations of the anatomy orbital apex and its structures. There is no precise definition of what the orbital apex comprises and its precise location. We systematically review all current data and reports on the anatomy of the orbital apex. An attempt was made to develop a conclusive definition of the orbital apex
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